Multiple endocrine neoplasia type 1 presenting with refractory seizures

Area of Science:

• Endocrinology
• Neuroscience
• Oncology

Background:

• Refractory epilepsy presents a significant clinical challenge.
• Hyperinsulinemic hypoglycemia can manifest with neurological symptoms, including seizures.

Observation:

• A 29-year-old woman with refractory epilepsy experienced recurrent hypoglycemia during seizures.
• Investigations revealed hyperinsulinemic hypoglycemia, a pancreatic head neuroendocrine tumor, pituitary microadenoma, and parathyroid adenoma.

Findings:

• The patient was diagnosed with multiple endocrine neoplasia type 1 (MEN1).
• Surgical resection of the pancreatic tumor and bromocriptine treatment led to complete seizure remission.
• Postoperative follow-up showed no seizures, even without antiepileptic drugs.

Implications:

• This case underscores the importance of investigating metabolic causes, such as hyperinsulinemic hypoglycemia, in patients with refractory epilepsy.
• Multiple endocrine neoplasia type 1 should be considered in cases with co-occurring endocrine tumors and unexplained seizures.
• Early diagnosis and appropriate management of MEN1-associated tumors can significantly improve patient outcomes and quality of life.